Recent headlines about a “common back-pain drug” refer to gabapentin, a medication often prescribed for chronic low back pain and nerve pain. A large observational study found that people with chronic low back pain who received repeated gabapentin prescriptions had a higher likelihood of later being diagnosed with dementia or mild cognitive impairment (MCI).
What did the study find?
Researchers analysed electronic health records from more than 26,000 adults with chronic low back pain. They compared patients who received gabapentin prescriptions with similar patients who did not receive the drug.
The main findings included:
- People prescribed gabapentin had about a 29% higher risk of developing dementia.
- They had an 85% higher risk of developing mild cognitive impairment (MCI), a condition involving noticeable problems with memory and thinking that can sometimes progress to dementia.
- The association appeared stronger in younger and middle-aged adults (35–64 years) than in older adults.
- Patients who received more prescriptions (12 or more) appeared to have an even greater risk, suggesting a possible dose-response relationship.
Does this prove gabapentin causes dementia?
No. This is the most important point.
The study was observational, meaning it found an association, not proof that gabapentin directly causes dementia.
There are several possible explanations:
- People requiring long-term gabapentin may have more severe chronic pain.
- Chronic pain itself has been linked with cognitive decline.
- Other health conditions, medications, lifestyle factors, or differences between patients could have influenced the results despite statistical adjustments.
Why might there be a link?
Researchers have proposed several possibilities, but none has been confirmed.
Potential explanations include:
- Long-term effects of gabapentin on brain signalling.
- The impact of chronic pain on brain health.
- Shared risk factors such as depression, poor sleep, diabetes, or vascular disease.
More research, including prospective studies and clinical trials, is needed to determine whether gabapentin itself contributes to dementia risk.
Should people stop taking gabapentin?
Experts do not recommend stopping gabapentin based on this study alone.
Gabapentin is an effective treatment for some conditions, including:
- Nerve pain (neuropathic pain)
- Postherpetic neuralgia (pain after shingles)
- Certain types of epilepsy
- Some other conditions when prescribed by a clinician
Stopping gabapentin suddenly can cause withdrawal symptoms and, in people taking it for seizures, may increase seizure risk. Any changes should be discussed with the prescribing healthcare professional.
What should patients do?
If you take gabapentin:
- Continue taking it unless your healthcare provider advises otherwise.
- Discuss the benefits and potential risks if you need long-term treatment.
- Report any new memory problems, confusion, or changes in thinking.
- Ask whether non-drug treatments or alternative pain-management approaches might be appropriate.
Bottom line
The study raises an important safety question but does not establish that gabapentin causes dementia. It suggests that long-term or repeated use in people with chronic low back pain is associated with a higher risk of dementia and mild cognitive impairment, particularly in younger adults. Researchers emphasise that further studies are needed before clinical recommendations change.